States try to protect the public from receiving incompetent care by licensing certain health professions. Certification differs from licensing, in that certification:
only recognizes special education or training
At the outset of the nurse practitioner movement, educational requirements were often limited to relatively short certificate programs. Today, it is generally accepted that nurse practitioners should be registered nurses with:
a master’s degree
Complementary medicine differs from alternative medicine in that complementary medicine:
is used together with conventional medical treatment while alternative medicine is used in place of conventional medical treatment
A physician residency training program is best described as:
an accredited training program of at least 3 years post-medical school, that prepares physicians to practice in a medical specialty
Major obstacles to ensuring an efficient and rational health workforce in the future include:
separate and often conflicting interests of governments, educational institutions, professional organizations, insurers and providers
Health care system changes, including advancing technology, will likely result in new and more highly specialized health occupations. Which of the following is NOT one of the expected effects of this development?
hospitals becoming more resistant to employing multi-skilled personnel
Each year approximately 6,000 international medical graduates (IMGs) enter the U.S. to practice. IMGs are vitally important to the health care delivery system because they
they fill a shortfall in the number of residents required by US hospitals
Unlike medicine, dentistry primarily serves only those with dental insurance or who can afford to pay out-of-pocket. For this reason
many of the population groups with the greatest need have no access to service
The category of allied health professionals, “therapeutic science practitioners” concerned with the treatment and rehabilitation of patients with all types of diseases and injuries include which of the following professions?
physical and occupational therapists, speech language pathologists
The widespread use and popularity of complementary and alternative medicine in the U.S. resulted in which of the following developments?
the national institutes of health creating the national center for complementary and alternative medicine (NCCAM)
The ACA addressed numerous long-standing health workforce issues. Most importantly, it established the National Health Care Workforce Commission with the overall mandate to
evaluate and make recommendations in areas such as training and support for workers at all levels, efficient workforce deployment professional compensation, and coordination among different types of providers
Major obstacles to ensuring an efficient and rational health workforce in the future include
separate and often conflicting interest of governments, educational institutions, professional organizations, insurers, and providers
The managed care concept called “capitation” refers to:
physicians agreeing to provide all medical care an individual requires for a specified time period, for a prepaid fee
By focusing on insured populations rather than individuals, managed care organizations can project health service use by:
demographic factors such as age, gender, and other factors
An aim of managed care is to transfer some measure of financial risk to providers and, to a lesser extent, to patients. Transferring financial risk to patients is accomplished by:
requiring co-pays for specified services
The phenomenon of managed care “backlash” is best characterized by which of the following:
protests of organized medicine, other health care providers and consumers against MCO policies viewed as unduly restrictive
In retrospect, implementation of the DRG system demonstrated that:
hospitals could profit from instituting more efficient patient care procedures
Although the ACA will enact sweeping U.S. health care system reforms, one fundamental element of the system that will remain unchanged is
financing of health care expenditures through a combination of public and private sources
The current highest personal care expenditure in the U.S. is for
Despite U.S. health care spending exceeding the expenditures of 28 other developed nations, U.S. health outcomes lag far behind. Extensive research has concluded that reasons for high U.S. health expenditures include
higher US per capita income and much higher US prices for medical care
Major drivers of U.S. health expenditures include
advancing medical technology, growth in the older population, and reimbursement system incentives
The basic concept of health insurance is different than the premise on which personal or property insurance was historically defined because
other forms of insurance were intended to cover individuals against the low risk of unlikely events while health insurance provides coverage for unlikely events in addition to routine and discretionary services.
The establishment of Blue Cross for hospital care and Blue Shield for physicians’ services signaled a new era in health care delivery and financing. Which of the following was NOT among their major impacts?
caused for-profit insurers to use “experience” rather than “community” ratings to establish premiums
The 1973 HMO legislation responded to which of the following national concerns?
rapidly increasing Medicare expenditures and concerns about the quality of care
Cost-control initiatives undertaken by managed care organizations to improve communications with chronic disease patients in the hope of avoiding unnecessary, costly care are known by the term
The most influential managed care quality assurance organization that accredits many different aspects of managed care organizations on a voluntary basis is
the national committee on quality assurance
The Healthcare Effectiveness Data and Information Set (HEDIS) may be best described as
a standardized method for managed care organizations to collect, calculate and report information about their performance to facilitate purchasers’ and consumers’ comparisons of different insurance plans on a variety of parameters.
The Medicare program enacted in 1965 as Title XVIII of the 1935 Social Security Act is characterized as the most sweeping social legislation ever enacted by the federal government because it
was only the second mandated U.S. health insurance program after worker’s compensation and signaled the federal government’s entry into the personal healthcare financing arena.
Enacted in 1983, the Diagnosis-related Group payment methodology shifted hospital reimbursement from the retrospective to prospective basis. The major purpose of this new payment system was to
provide financial incentives for hospitals to spend no more than needed to produce optimal outcomes for hospitalized patients.
The primary purpose of the Centers for Medicare & Medicaid Services “Hospital Compare” web-based program is to
provide consumers with objective criteria that allow comparisons of hospitals’ use of evidence-based practices and patient satisfaction ratings.
Enacted in 1965 as Title XIX of the Social Security Act, Medicaid is
a joint federal-state program supporting basic health services for low income individuals in which federal and state support is shared based on a state’s per capita income.
The intent of the Medicaid Child Health Insurance Program (CHIP) was to
enroll 10 million uninsured children in Medicaid whose family incomes were too high to qualify for Medicaid but too low to purchase private health insurance.
Medicaid and CHIP quality initiatives are carried out through partnerships with the respective states’ programs using five quality criteria that include which of the following?
prevention and health promotion, management of acute conditions, management of chronic conditions, family experience of care, availability of services
Under the ACA, most Americans will be required to have health insurance or be penalized with an annual tax. In the ACA legislation, this requirement is popularly known as the
As defined and required by the ACA, health insurance exchanges (HIEs) intend to
create a competitive health insurance market by providing web-based, easily understandable comparative information to consumers on plan choices with standardized rules regarding health plan offers and pricing.
The ACA’s “Bundled Payments for Care Improvement Initiative” intends to address which of the following long-standing concerns about the Medicare program’s costs and quality?
fee-for service payments for individual services provided during a beneficiary’s illness resulting in fragmented care with minimal coordination across providers and settings that result in rewarding service quantity rather than quality.
Long-term care is best described as:
services provided in both home and institutional settings for persons of all ages with varying levels of medical, social, and personal care needs.
The US history of institutional long-term care began with:
communal care settings operated by charitable community members and government supported almshouses.
Which of the following societal factors increases the need for formal long-term care services?
all of the above
The development of formal home care services, such as those provided by the Visiting Nurses Association originated as:
a social response intended to improve unhealthy living conditions of immigrants residing in crowded urban tenements and prevent the spread of infectious diseases.
Long-term care and nursing-home reform legislation of the 1970s occurred as a response to which of the following:
widespread media reports and ensuing Congressional hearings on nursing home and residential care facility abuses and negligence
The major distinction between skilled-nursing and residential care facilities is that skilled nursing facilities:
provide care primarily for people requiring intensive nursing, rehabilitation, or related services.
Which of the following was not a driver of expanded home care services during the 1980s through the 1990s?
audits documenting significant fraud and abuse of Medicare billing.
Which of the following best describes the informal long-term care system?
care and assistance provided in the home by family members and friends
Respite care is best defined as:
temporary, Medicaid-supported vacations for caregivers of a physically or mentally-dependent family member.
The enactment of Medicare and Medicaid in 1965 affected the long-term care industry in many ways. Which of the following was NOT an effect of the Medicare and Medicaid enactment on the long-term care industry?
Prohibition of for-profit providers’ participation in Medicare and Medicaid long-term care reimbursement
The hospice movement is concerned with care for terminally ill patients. Which of the following is not a major goal of hospice care?
decreasing costs of care for the terminally ill by avoiding use of expensive technology
The “naturally occurring retirement community” is best defined as
apartment complexes, neighborhoods, or sections of communities where residents have opted to age-in-place.